额窦区域内翻性乳头状瘤的手术治疗

Manangement of inverted papilloma in frontal sinus

目的探讨额窦内翻性乳头状瘤的治疗方法。方法介绍1999-2006年采用内镜＋开放进路（眼眉内飞鸟状切口）手术治疗的6例额窦内翻性乳头状瘤的临床资料，结合国内外文献，探讨额窦内翻性乳头状瘤的起源部位、临床表现、影像学检查、肿瘤的分期与分类、手术方法、放射治疗、预后等相关问题。结果6例额窦内翻性乳头状瘤患者手术后随访时间2～8年，中位随访时间2．5年。除1例患者因肿瘤复发和恶变，拒绝治疗死亡外，其余5例肿瘤均未复发。3例接受了手术后放疗，其中1例在放疗3年后恶变为中分化鳞癌，1例3年后出现了上颌骨放射性骨髓炎。结论对于原发或侵犯额窦的内翻性乳头状瘤，可以选择内镜＋鼻外联合进路手术。由于肿瘤侵犯额窦最外侧、最上部以及前壁是当前内镜下手术的死角，单纯在内镜下不可能将肿瘤切除干净，开放性切口还是有必要的。为了避免复发，手术中应在直视下力求将肿瘤切除干净，手术后放疗应慎重。

Objective To introduce the experience of management of inverted papilloma in frontal sinus in hospital. Methods Six patients with inverted papilloma in frontal sinus treated between 1999 and 2006 were reported, with special emphasis on the clinical symptoms, surgical technique and prognosis. Results Among 6 patients with frontal sinus involvement, there were 5 males and 1 female, aged between 24 and 66 years. All 6 patients were managed with endoscopic resection and additional open approach （glabellar nasal keyhole approach）. Follow-up ranged from 2 - 8 years. Five patients treated with this protocol remained disease free, and 1 patient died of tumor recurrence and malignant degeneration 16 years after the first surgical management of sinonasal inverted papilloma. Condusions The appropriate management of inverted papilloma involving the frontal sinus is combined open/endoscopic approach. The tumor extended into the lateral, far superior, and anterior aspects of the frontal sinus is truly at the limits of current endoscopic instrumentation. In order to avoid recurrence, the tumor must be resected completely during the operation. Postoperative radiotherapy is not absolutely necessary.